Gender Dysphoria Diagnosis

These are the diagnostic criteria for Gender Dysphoria in the DSM-V (2013). Gender Dysphoria in this context is not synonymous with being transgender, and refers to the mental distress experienced by having a gender identity at odds with one’s physical body or lived gender. It is classified as a mental illness similar to depression. This distress has to be clinically significant for a diagnosis to be made.

Medical authorities recommend transitioning as the treatment for GD, as it is the only course of action that has proven consistently and permanently effective in alleviating dysphoria.

Some transgender people may not qualify for a diagnosis of Gender Dysphoria if their distress is not intense enough to be debilitating. They may still desire and benefit from transitioning.

DSM-V Diagnostic Criteria for Gender Dysphoria in adults and adolescents

A definite mismatch between the assigned gender and experienced/expressed gender for at least 6 months duration as characterized by at least two or more of the following features –

Persistent desire to rid oneself of the primary or secondary sexual characteristics of the biological sex at puberty.

Strong desire to possess the primary and/or secondary sex characteristics of the other gender

Desire to belong to the other gender

Desire to be treated as the other gender

Strong feeling or conviction that he or she is reacting or feeling in accordance with the identified gender.

The gender dysphoria leads to clinically significant distress and/or social, occupational and other functioning impairment. There may be an increased risk of suffering distress or disability.

The subtypes may be ones with or without defects or defects in sexual development.

DSM V Diagnostic Criteria for Gender Dysphoria in children

A definite difference between experienced/expressed gender and the one assigned at birth of at least 6 months duration. At least six of the following must be present:

Persistent and strong desire to be of the other sex or insistence that they belong to the other sex

In males a strong preference for cross-dressing and in female children a strong preference for wearing typical masculine clothing and dislike or refusal to wear typical feminine clothing

Fantasising about playing opposite gender roles in make-belief play or activities

Preference for toys, games, or activities typical of the opposite sex.

Rejection of toys, games and activities conforming to one’s own sex. In boys avoidance of rough-and-tumble play and in girls rejection of typically feminine toys and activities

Preference for playmates of the other sex

Dislike for sexual anatomy. Boys may hate their penis and testes and girls dislike urinating sitting.

Desire to acquire the primary and/or secondary sex characteristics of the opposite sex.

The gender dysphoria leads to clinically significant distress and/or social, occupational and other functioning impairment. There may be an increased risk of suffering distress or disability.

The subtypes may be ones with or without defects or defects in sexual development.

To Note:

While it’s less the case than it was with the DSM-IV or DSM-III (which came out in 1980, but which Singapore psychiatrists currently still refer to for trans patients), the diagnostic criteria listed above for children is still likely to produce a few false positives. Many trans children meanwhile may not meet the criteria – for instance, a trans girl who enjoys typically masculine activities but has an intense, debilitating desire to be female would meet only 2 or 3 of the 6 required criteria, despite being very likely to persist in a transgender identity. Whereas an effeminate boy who is repeatedly forced into masculine activities against his will and might express a desire to be a girl out of that frustration (and vice versa) would meet at least 5 and perhaps even all 6 of the required criteria, despite being unlikely to grow up to be transgender.

This is important in light of the oft-repeated claim that a 80-90% of transgender children grow out of their gender dysphoria and do not become transgender adults but instead gay or lesbian. Many of those studies were done on children diagnosed under the DSM-III (1980), III-R (1987) and IV (1994). The DSM-IV criteria in particular did not require children to express a desire to be the other sex in order to be considered transgender; they merely needed to exhibit a strong pattern of gender-atypical interests and behaviour (manifested in forms of play, preferred clothing, and gender of playmates), which in most cases has no bearing on their actual gender identity.

While the DSM-III did require children to express a strong and persistent desire to be the other gender, it was also published during a time where stereotypical gender roles were a lot more rigid than they are today. This raises the possibility that many of those children’s declarations of wanting to be the other sex were the result of their frustration with gendered restrictions, rather than distress at being a boy or girl per se.

Adults were likewise not immune to this conflation of gender stereotypes and identity. The DSM-III described gender dysphoria in girls as follows: “Girls with this disorder regularly have male peer groups, an avid interest in sports and rough-and-tumble play, and a lack of interest in playing with dolls or playing “house”.”

Today, we know such girls to be tomboys, not transgender boys. It is thus no surprise that the majority of such girls grew up to be perfectly content as women (and likewise for boys), but this result cannot be extrapolated to transgender children whose distress extends beyond merely having atypical interests for their sex, and who do not find this distress eliminated by merely being given the freedom to act and dress as they like.

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